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American Association for Hand Surgery
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Theme: Inclusion and Collaboration Theme: Inclusion and Collaboration

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Open Reduction and Internal Fixation of Radial Head Fractures: Screws or Plates?
Justin Mirza, MD; M Ather Mirza, MD
Massachusetts General Hospital, Boston, MA

Submission: Poster or presentation

Title: Open Reduction and Internal Fixation of Radial Head Fractures: Screws or Plates?

Authors: J. Lans, B. Notermans, Q. van der Vliet, J. Jupiter, N. Chen

Introduction: It is unclear what factors are associated with reoperation after open reduction and internal fixation (ORIF) of radial head and neck fractures. We evaluated what patient-, fracture- and treatment characteristics were associated with reoperation after radial head ORIF.

Material and Methods: We retrospectively identified all patients that underwent primary ORIF of a radial head fracture using Current Procedural Terminology codes. All adult patients that were treated between 2002 and 2015 at a single institutional system were included (n=108). A medical chart review was performed to collect data regarding demographics, fracture- and treatment characteristics along with postoperative complications and indications for reoperation. There were 2 (3.3%) Mason I fractures, 21 (34.4%) Mason II fractures, 23 (37.7%) Mason III fractures and 15 (24.6%) Mason IV fractures. Most of the patients underwent screw fixation (75.9%), 24 of the patients had plate fixation and 2 patients had other types of fixation (Kirschner wire and suture fixation). All explanatory variables with a p-value <0.10 were included in a multivariate logistic regression.

Results: The reoperation rate after radial head ORIF was 22.9% (25 of 109) during a median follow-up of 6.9 months (IQR 2.9 13.8). After adjusting for fracture type (radial neck fracture versus radial head fracture), plate fixation was found to be an independent predictor for reoperation compared to screw fixation (OR 5.19, 95% CI: 0.093-0.32, p=0.004). Implant irritation was the leading (59.3%) cause for reoperation, followed by restricted motion (30%), heterotopic ossification (14.8%), pain (11.1%) and infection (7.4%).

Conclusion: Although plate fixation may be feasible for radial head fractures, this technique increases the odds of reoperation by 5 compared to screw fixation. When choosing fixation techniques, it may be preferable to perform fixation with only screws when possible.

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